WASHINGTON — The Supreme Court on Thursday upheld virtually all of President Barack Obama's historic health care overhaul, including the hotly debated core requirement that nearly every American have health insurance.
The 5-4 decision meant the huge overhaul, still taking effect, could proceed and pick up momentum over the next several years, affecting the way that countless Americans receive and pay for their personal medical care.
The ruling hands Obama a campaign-season victory in rejecting arguments that Congress went too far in approving the plan. However, Republicans quickly indicated they will try to use the decision to rally their supporters against what they call "Obamacare," arguing that the ruling characterized the penalty against people who refuse to get insurance as a tax.
Obama declared, "Whatever the politics, today's decision was a victory for people all over this country." GOP presidential candidate Mitt Romney renewed his criticism of the overhaul, calling it "bad law" and promising to work to repeal it if elected in November.
Breaking with the court's other conservative justices, Chief Justice John Roberts announced the judgment that allows the law to go forward with its aim of covering more than 30 million uninsured Americans. Roberts explained at length the court's view of the mandate as a valid exercise of Congress' authority to "lay and collect taxes." The administration estimates that roughly 4 million people will pay the penalty rather than buy insurance.
Even though Congress called it a penalty, not a tax, Roberts said, "The payment is collected solely by the IRS through the normal means of taxation."
Roberts also made plain the court's rejection of the administration's claim that Congress had the power under the Constitution's commerce clause to put the mandate in place. The power to regulate interstate commerce power, he said, "does not authorize the mandate. "
Stocks of hospital companies rose after the decision was announced, while shares of insurers fell sharply. Shares of drugmakers and device makers fell slightly.
The justices rejected two of the administration's three arguments in support of the insurance requirement. But the court said the mandate can be construed as a tax. "Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness," Roberts said.
The court found problems with the law's expansion of Medicaid, but even there said the expansion could proceed as long as the federal government does not threaten to withhold states' entire Medicaid allotment if they don't take part in the law's extension.
The court's four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the outcome.
Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented.
Kennedy summarized the dissent in court. "In our view, the act before us is invalid in its entirety," he said.
The dissenters said in a joint statement that the law "exceeds federal power both in mandating the purchase of health insurance and in denying non-consenting states all Medicaid funding."
In all, the justices spelled out their views in six opinions totaling 187 pages. Roberts, Kennedy and Ginsburg spent 51 minutes summarizing their views in the packed courtroom.
The legislation passed Congress in early 2010 after a monumental struggle in which all Republicans voted against it. House Majority Leader Eric Cantor, R-Va., said Thursday the House will vote the week of July 9 on whether to repeal the law, though such efforts have virtually no chance in the Democratic-controlled Senate.
After the ruling, Republican campaign strategists said Romney will use it to continue campaigning against "Obamacare" and attacking the president's signature health care program as a tax increase.
"Obama might have his law, but the GOP has a cause," said veteran campaign adviser Terry Holt. "This promises to galvanize Republican support around a repeal of what could well be called the largest tax increase in American history."
Democrats said Romney, who backed an individual health insurance mandate when he was Massachusetts governor, will have a hard time exploiting the ruling.
"Mitt Romney is the intellectual godfather of Obamacare," said Democratic consultant Jim Manley. "The bigger issue is the rising cost of health care, and this bill is designed to deal with it."
More than eight in 10 Americans already have health insurance. But for most of the 50 million who are uninsured, the ruling offers the promise of guaranteed coverage at affordable prices. Lower-income and many middle-class families will be eligible for subsidies to help pay premiums starting in 2014.
There's also an added safety net for all Americans, insured and uninsured. Starting in 2014, insurance companies will not be able to deny coverage for medical treatment, nor can they charge more to people with health problems. Those protections, now standard in most big employer plans, will be available to all, including people who get laid off, or leave a corporate job to launch their own small business.
Seniors also benefit from the law through better Medicare coverage for those with high prescription costs, and no copayments for preventive care. But hospitals, nursing homes, and many other service providers may struggle once the Medicare cuts used to finance the law really start to bite.
Illegal immigrants are not entitled to the new insurance coverage under the law, and will remain one of the biggest groups uninsured.
Obama's law is by no means the last word on health care. Experts expect costs to keep rising, meaning that lawmakers will have to revisit the issue perhaps as early as next year, when federal budget woes will force them to confront painful options for Medicare and Medicaid, the giant federal programs that cover seniors, the disabled, and low-income people.
The health care overhaul focus will now quickly shift from Washington to state capitals. Only 14 states, plus Washington, D.C., have adopted plans to set up the new health insurance markets called for under the law. Called exchanges, the new markets are supposed to be up and running on Jan. 1, 2014. People buying coverage individually, as well as small businesses, will be able to shop for private coverage from a range of competing insurers.
Most Republican-led states, including large ones such as Texas and Florida, have been counting on the law to be overturned and have failed to do the considerable spade work needed to set up exchanges. There's a real question about whether they can meet the deadline, and if they don't, Washington will step in and run their exchanges for them.
In contrast to the states, health insurance companies, major employers, and big hospital systems are among the best prepared. Many of the changes called for in the law were already being demanded by employers trying to get better value for their private health insurance dollars.
"The main driver here is financial," said Dr. Toby Cosgrove, CEO of the Cleveland Clinic, which has pioneered some of the changes. "The factors driving health care reform are not new, and they are not going to go away."
The Medicaid expansion would cover an estimated 17 million people who earn too much to qualify for assistance but not enough to afford insurance. The federal and state governments share the cost, and Washington regularly imposes conditions on the states in exchange for money.
Roberts said Congress' ability to impose those conditions has its limits. "In this case, the financial 'inducement' Congress has chosen is much more than 'relatively mild encouragement' — it is a gun to the head," he said.
The law says the Health and Human Services Department can withhold a state's entire Medicaid allotment if the state doesn't comply with the health care law's Medicaid provisions.
Even while ruling out that level of coercion, however, Roberts said nothing prevents the federal government from offering money to accomplish the expansion and withholding that money from states that don't meet certain conditions.
"What Congress is not free to do is to penalize states that choose not to participate in that new program by taking away their existing Medicaid funding," he said.
Ginsburg said the court should have upheld the entire law as written without forcing any changes in the Medicaid provision. She said Congress' constitutional authority to regulate interstate commerce supports the individual mandate. She warned that the legal reasoning, even though the law was upheld, could cause trouble in future cases.
"So in the end, the Affordable Health Care Act survives largely unscathed. But the court's commerce clause and spending clause jurisprudence has been set awry. My expectation is that the setbacks will be temporary blips, not permanent obstructions," Ginsburg said in a statement she, too, read from the bench.
In the courtroom Thursday were retired Justice John Paul Stevens and the wives of Roberts, Alito, Breyer, Kennedy and Thomas.
Associated Press writers Ricardo Alonso-Zaldivar, Charles Babington, Jessica Gresko, Jesse J. Holland and David Espo contributed to this report.
Dale Whiting posted at 8:12 am on Thu, Jun 28, 2012.
OK, all you Neo-cons out there, just as I predicted. SB1070 has largely been gutted. The remaining challenged provision, the "requirement" that police check immigration status during all stops where they have reasonable grounds to question it, has been placed on probation. If it does turn into a Joe Arpaio "free for all" where all Hispanic looking detainees are suspected, even that can be ruled unconstitutional.
AND NOW we have the Affordable Healthcare act [known by some as Obamacare, by others as Romneycare, pased upon the Indifidual Mandate which, during the Clinton years when Hilarycare, was attempted was a Republican Idea - yes, folks, a Republican Idea] ruled constitutional as a tax. I predicted it would fail under the Commerce Clause. And it did fail under Commerce. But it passed as a tax, a tax on those who fail to self insure and therefore would get "free healthcare" in emergency rooms.
Now Leon and others are complaining about how illegal immigrants get such free healthcare. Why stop complaining there?
So either go back and read then study professionally the US Constitution, or just quit complaining like you understand it. You don't, at least not according to that Conservative Chief Justice of the United States Supreme Court, John Roberts.
abimopectore posted at 9:28 am on Thu, Jun 28, 2012.
There's no doubt that Judge Roberts chose a tortuous manner by which to uphold the individual mandate. It would have been better to let Congress do their job by submitting it as a tax instead of the Court generously interpreting it as a tax when it was clearly written as a mandate. As duly noted however within the decision, the opinion states, "We do not consider whether the Act embodies sound policies." It now sets up an election year rallying cry. The GOP is going to run on this and the economy since it's now imperative to elect legislators that will undo what's been done. This law has now been saved by a big assist by Judge Roberts but I don't think we've heard or seen the last of it.
chatmandu002 posted at 9:43 am on Thu, Jun 28, 2012.
November can't come fast enough.....
Juggernaut8000 posted at 10:05 am on Thu, Jun 28, 2012.
November will be here soon and our traitor president will win the election because he has secured the hispanic vote because he has just granted amnesty to illegals.
If you happen to be white, hard working and have a job, prepare for the worst.
Dale Whiting posted at 10:12 am on Thu, Jun 28, 2012.
Or, obimopectore, we could improve on the bill, addressing areas the had to be left hanging to get support from the medical and other communities. Here is a short list of objections to this bill.
1) Government, particularly the federal government, has not business running healthcare. But does this bill place government in charge of healthcare? No, it does not, not any more than it already is. We already have Medicare, Medicaid [Arizona was a leader in its own version of Medicaid - AHCCCS - the Arizona Healthcare Cost Containment System. Must we dump these programs, too?
2) Government programs are not efficient! [Of course this implies that private systems are efficient. They are not! The healthcare insurance industry spends upwards of 20% of the premiums collected on administrative expenses aimed exclusively at denying coverage. This bill - now constitutional law - makes insurers cover and thereby redirects those premiums towards real medical procedures, not bureaucratic expenses.
3) Government programs are poorly run. The medicine is poor. [I and my fellow veterans have benefitted by VA programs. And the Bureau of Indian Affairs runs a modely program for healthcare of Native Americans. The diabetes clinic down south on the Gile River Indian Community is a national model of an effective program for treatment of diabetes. And it's run by local government.]
4) This law will increase overall costs for medical treatment of the typical person. [Perhaps. But many of those things left on the bench can be enacted now to reduce costs. They include:
a) Pharmasuticals - medicines made in the US and sold in the US cost more money than when they are sold in Canada and elsewhere! Why?]
b) Medical Malpractice - many doctors spend more money on insurance coverage than they take home in pay! Why? We have a mess of standards for what constitutes medical malpractice. Why the standards in Arizona vary from Phoenix to Flagstaff, Yuma to Tuba City! Why not establish a national criteria, one well defined and supported in all areas?
c) Medical Records - every tried to switch doctors or plans? It cost me $55 to have five years of Cigna records copied and delivered to the VA! The VA records system is automated. I can switch clinics, hospitals, doctors, and all can assess the same records.
We either can modernize our antiquated medical system in the US or remain far behind the rest of the world. It would appear that chatmandu002 and abompspectore would have us remain behind. Is that the conservative way? Apparently so!
Accuracy posted at 10:29 am on Thu, Jun 28, 2012.
The U.S. Supreme Court has upheld the individual mandate in President Obama's controversial healthcare law, in a 5-4 ruling . . . thanks to Chief Justice John Roberts. With the requirement that Americans purchase health insurance can stand as a tax – meaning Congress can tax Americans if they do not purchase (ObamaCare) health insurance.
"The act before us here exceeds federal power both in mandating the purchase of health insurance and in denying non-consenting states all Medicaid funding," the dissenting justices said in a joint statement.
Today's high court decision does not change the fact that ObamaCare's mandates, tax hikes, and Medicare cuts are deeply damaging to our health care system and our economy. And strong Conservatives must go on to completely repeal and replace ObamaCare with commonsense reforms in the upcoming November election.
Dale Whiting posted at 11:12 am on Thu, Jun 28, 2012.
Accuracy,
Make up you mind, please!
When Healthcare reform was attempted during the Clinton Administration, Hillarycare did not include an individual mandate. It was a public option, a truely government run public healthcare insurance plan. The individual mandate was a conservative idea offered up instead. So if the individual mandate was a conservative idea in the 90's and is now a liberal idea, what changed?
And please do list some of your "commonsense reforms." I've yet to hear any specifics from Eric Cantor, John Beyhner and certainly not Mitt Romney. His last healthcare idea was a public option in MA which has resulted in coverage for over 99% of Massachusetts citizens. Sounds like success to me!
In December of 2012, remember Obamacare = Romneycare. Just ask his primary campaign opponents!
Cerulean posted at 11:34 am on Thu, Jun 28, 2012.
Good points all, Dale.
Accuracy said, "Conservatives must go on to completely repeal and replace ObamaCare with commonsense reforms in the upcoming November election."
It would be interesting if this person had told us what commonsense reforms are, however he/she left that to any ones imagination. Therefore, there are none.
VofReason posted at 12:36 pm on Thu, Jun 28, 2012.
Yes, no Republican or anyone else has suggested that they allow Health Insurance be sold over state lines to create competition. Nope, only the Democrates have an idea here. And yes MA had something similar, but low and behold, it did nothing to make Healthcare more affordable. It made premiums increase by 10%. Similarly, Obamacare has done nothing to reduce the cost of Healtcare (someone once said competition brings down cost?) and it hasn't even yet fully kicked in. Reality is, most people who never have had to pay, still don't, people who have paid all along now paymore, and a few people inbetween are getting real benefits from some good parts of the law.
REG in AZ posted at 1:38 pm on Thu, Jun 28, 2012.
The Republican / Tea Party individuals, like Bachmann, Romney and others are now trying to use the supreme court’s decision for political purposes, like they did all along with the Health Care Reform Act, and sway people to see the decision as being a negative and to then contribute to and vote Republican in order to repeal the act. NOWHERE do they demonstrate any real concern for the people, just aggressively for their political ambitions. Had they been honest, responsible and had a conscience for the people, as they should now, right from the start they would have worked at offering bipartisanship, cooperation and compromise to fine tune health care reform - instead, as they are once again, they put their political tactics, their political ambitions and their loyalty to Special Interests above all else - no matter what the costs to the people. Absolutely ridiculous and disgusting.
Cerulean posted at 3:20 pm on Thu, Jun 28, 2012.
President Obama Reacts to Supreme Court’s Health-Care Ruling
https://www.youtube.com/watch?v=D8TlGrRZ5AE&feature=player_embedded#!
It’s a good thing.
Accuracy posted at 4:32 pm on Thu, Jun 28, 2012.
President Obama always claimed the ObamaCare bill WAS NOT a TAX.
Congress cannot force Americans to buy anything, but they can tax them if they don't. So, while defending it at the Supreme Court, the President's attorneys argued that it was a tax.
The court said the mandate is only legal if it's a tax because Congress has the power to tax.
When President Obama spoke today on the Supreme Court’s decision to uphold the Affordable Care Act, he said nothing about how it could represent the largest middle class tax increase in American history.
chatmandu002 posted at 4:48 pm on Thu, Jun 28, 2012.
The Supreme Court has confirmed that Obama and the democrats have passed the largest TAX increase in American history.
chatmandu002 posted at 4:56 pm on Thu, Jun 28, 2012.
Next from Obama and the democrats is that families making less than the poverty level will be exempt from the healthcare mandate tax and than families making more than $250K will have to pay extra in healthcare tax to support those that are exempt.
Cerulean posted at 6:28 pm on Thu, Jun 28, 2012.
Chatmandu, professional lie #2. The largest tax increase to hit Americans was in WWII when the U.S. raised taxes to pay for the war. Unlike Bush, who chose to put the Iraq war on a credit-card. Republicans can’t handle all their failures so now they are going through a self-delusional phase.
Dale Whiting posted at 6:50 pm on Thu, Jun 28, 2012.
Careful Cerulean, your net is cast a bit too wide.
I'm a registered Republican. And unlike many of my fellow Republicans, I did not get deluded. Those who did, I call Neo-conservatives. They got deluded by the likes of Karl Rove, Eric Cantor and Jon Beyher. Mitch McConnell summed things up nicely. Rather than focusing on legislation, even bi-partisan legislation to address economic issues, House and Senate Republicans, especially TeaParty Republicans have focused on defeating the President in 2012. I say, "Let's us show these Neo-cons the door!"
And like most of the rest of us, many Republicans included, Mitt Romney has yet to show is anything. Smoke and mirrors is all he's given us so far.
DrJCA1 posted at 8:43 pm on Thu, Jun 28, 2012.
While not getting into this debate, the economics are very clear to those of us in the healthcare business. This law will increase spending throughout the country, not decrease it. First of all, who is going to pay for the hundreds of billions for rebates, vouchers, or any other nonsense to the 10s of millions of folks who will fall under the "can't afford to buy insurance" umbrella? Secondly, proportionately poorer people have more health care problems and costs, so most of this program is geared towards these folks. If you think health costs are high now, just wait until this "free insurance for all" idiocy kicks in. I honestly believe that very libreal folks think the money supply in this country is completely unending. There's a reason we're 16 trillion in the hole and adding more every day. If we had just a few million people who needed government help, we would be OK. When almost half the country is on some form of welfare or government assistance, we're in very deep doo-doo.
Cerulean posted at 8:44 pm on Thu, Jun 28, 2012.
Dale, I apologize. I often forget that there are quite a lot of non-delusional Republicans.
REG in AZ posted at 10:12 am on Fri, Jun 29, 2012.
The big question in this election is "will the people allow money to control them, their voting and thereby their ongoing status?" We have seen the money successfully manipulate the people with the manipulation of the "conservative" Christian (2000), the Swift-boat propaganda (2004), the Tea Party Movement (2010) and recently with the mega-millions poured into the Wisconsin recall election, all being well designed, well funded and well directed efforts that influenced elections. All of those were ultimately costly to the majority as "the money" doesn't give without strings attached and those strings are for their interests only – the results being clearly seen in the country continually being pushed further into being a two-class society with "the few – the money" competing in having it all while the majority looses more. ... Can the voters recognize the manipulation, refuse to accept the propaganda and reject the "puppet" candidates "the money" has on the end of their "strings"?
REG in AZ posted at 1:12 pm on Fri, Jun 29, 2012.
If the GOP is successful then the people loose. Not based on policy differences between the Democrats and the Republicans, as always there are pros and cons there, but rather because over the last twelve years the Republicans have clearly proven they are owned and controlled by "the money", who strongly support them and dictate to them, focusing all of their efforts on serving only "the money" and on together using their power, influence and mega-bucks to con the people and manipulate public opinion. No where in any of it is there any honest or responsible consideration of the majority, just a cocky, stubborn and arrogant attitude that says they continually take the people for granted as being "pawns" to be duped, used and abused. That is reality and it is very evident in all they do as can simply be recognized by anyone who can be rational and objective with emotions and past loyalties checked.
fae4now posted at 10:55 am on Sun, Jul 1, 2012.
Well said Reg[thumbup]
REG in AZ posted at 2:06 pm on Tue, Jul 3, 2012.
If the Republicans had the people's interests in mind, then their efforts would be creditable. However if they really had the people's interests in mind, not just their political ambitions and the need to cater to Special Interests (their strong supporters), they would have worked with bipartisanship, compromise and cooperation to fine-tune the law and make it AmericasCare. No they fought all efforts, stubbornly blocking and arrogantly faulting, no matter what irresponsibility and neglect that entailed. Now they want the public to trust them to repeal the law and they promise (with tongue in cheek) to replace it with something more workable and equitable. There is no evidence they can be trusted to serve anything but their own interests and that includes continuing to cater to Special Interests for their continued support - but there is considerable evidence that health care reform is desperately needed - and, with the propaganda set aside, Obamacare provides much of what is needed with costs and problems that aren't even close to what it is being faulted for (the misleading biased propaganda). The Republicans say that they are advocating what the people want but that is proven to be a lie and as the facts become more clear, the polls show more people supporting Obamacare with a large majority not wanting it to be repealed but rather adjusted where needed. Whose interests do they represent - obviously not the people's.
REG in AZ posted at 1:53 pm on Thu, Jul 5, 2012.
Contrary to what the Libertarian’s advocate, we really need the Federal government and contrary to what the Republicans practice, we need government to focus on more than just the few, more than just “the money”. That leaves the Democrats as the choice and if most feel they are too liberal, then we need a strong new party to focus on fairly representing the majority, mainly the middle-class who really make the country work. The Republican philosophies of “the least amount of government is the best government” and “government should only do for the people that which they can’t do for themselves” have real merit but they also have serious responsibilities which are dictated within those philosophies: i.e., government should be at least what is needed; and government needs to do what the people can’t do. Included in that is the need for government to protect the people from exploitation by the advantaged few and that has not only been neglected by the Republicans but they have actually encouraged and even been co-responsible for the exploitation, with their permissiveness and catering to the advantaged few, “the money”, their strong supporters, with that always being rationalized as “conservative”.
Should a new “people’s party” be desired, possibly it could be made up of those moderates being forced out of the Republican Party and of conservatives from the Democrats and any other centrists so inclined. As said, their focus would actually be on responsibly representing the majority, the middle-class. The problem of course is having the money needed to accomplish everything, including the vast sums necessary to effectively compete against the mega-millions being spent to propagandize, to con the people and manipulate public opinion, and to sell the “puppet” politicians owned and controlled by “the money”. Good luck with that one.
In the mean time, this country can’t further endure continually being exploited by the insatiable “more” (never enough) appetite of the few, a practice constantly pushing the country further into being a two-class society with the few having it all while the majority simply looses more - a reality clearly shown by the growing spread between them, reflecting the gains of the 1% and the losses of the 99%. The voters really need to prevent a return to “more of the same”, Bush-Cheney style, which once more would irresponsibly totally cater to the interests of the few while again giving the majority nothing more than an abundance of subterfuge and the drastic costs, which is what “the money” and the Republican / Tea Party are aggressively striving to achieve. It is up to the voters; good luck there too.